Fillable Printable Request For Records Disposition Authority
Fillable Printable Request For Records Disposition Authority
Request For Records Disposition Authority
Standard Form 115 (Rev.3/91)
Prescribed by NARA 36 CFR 1228
115-109 NSN 7540-00-634-4064
Previous Edition Not Usable
Request for Records Disposition Authority
(See Instructions on reverse)
To: National Archives and Records Administration (NIR)
Washington, DC 20408
1. From: (Agency or establishment)
2. Major Subdivision
3. Minor Subdivision
4. Name of Person with whom to confer 5. Telephone (include area code)
Leave Blank (NARA Use Only)
Job Number
Date Received
Notification to Agency
In accordance with the provisions of 44 U.S.C.
3303a, the disposition request, including
amendments, is approved except for items that
may be marked "disposition not approved" or
"withdrawn" in column 10.
Date Archivist of the United States
6.
Agency Certification
I hereby certify that I am authorized to act for this agency in matters pertaining to the disposition of its records and that the records proposed
for disposal on the attached page(s) are not now needed for the business of this agency or will not be needed after the retention
periods specified; and that written concurrence from the General Accounting Office, under the provisions of Title 8 of the GAO Manual for
Guidance of Federal Agencies:
is not required is attached has been requested
Signature of Agency Representative Title Date (mm/dd/yyyy)
7. Item
Number
9. GRS or
Superseded Job
Citation
10. Action taken
(NARA Use Only)
8. Description of Item and Proposed Disposition
Page of
